Functional Outcomes and Prognostic Markers After Ocular Trauma: A Nine‑Year Tertiary‑Care Cohort
DOI:
https://doi.org/10.48560/rspo.45412Keywords:
Acuidade Visual, Prognóstico, Traumatismos OcularesAbstract
INTRODUCTION: We aimed to characterize the clinical profile of ocular trauma over nine years in a Portuguese tertiary center and to identify independent predictors of final visual outcomes.
METHODS: Retrospective observational cohort study with 216 eyes of 216 patients admitted with ocular trauma between January 2015 and December 2023.
Demographic, clinical, and surgical data were retrieved from electronic medical records. Injuries were classified according to the Birmingham Eye Trauma Terminology (BETT). Final visual acuity (FVA) was categorized as ≥20/40, 20/40–20/400, or <20/400. Additional outcomes included no light perception (NLP) and evisceration. Associations between clinical variables and outcomes were assessed using non‑parametric tests, Kaplan–Meier survival analysis, and multivariable logistic and ordinal regression.
RESULTS: Open-globe injuries predominated, mainly penetrating trauma and globe ruptures. Poorer FVA was associated with older age (p=0.002), involvement of the posterior segment, more posterior BETT zones (p<0.001), and open-globe mechanisms, particularly rupture and perforating injuries (p<0.001). Increasing age independently increased the odds of worse FVA by 3.4% per year (OR 1.034, 95% CI 1.011–1.056, p=0.004), while injuries confined to the anterior segment were associated with a better visual outcomes (OR 0.09, 95% CI 0.03–0.22, p<0.001). Posterior segment involvement emerged as the only independent predictor of progression to no light perception (NLP) (aOR 0.14, 95% CI 0.03–0.55, p=0.005) and was also independently associated with subsequent evisceration (aOR 0.07, 95% CI 0.01–0.74, p=0.027), reflecting the most severe anatomical outcome in this cohort on multivariable analysis. Time to primary surgery was not significantly associated with visual outcomes.
CONCLUSION: In this nine-year tertiary-care cohort, age, posterior segment involvement, and severe open-globe mechanisms were key prognostic markers of poor visual outcome after ocular trauma. Injuries limited to the anterior segment conferred a markedly better prognosis, whereas posterior extension was the sole independent predictor of NLP and evisceration. These findings reinforce the importance of established prognostic factors and may support more realistic counselling of patients and their families after severe ocular trauma.
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